Thrombolytic therapy via streptokinase for prosthetic heart valve thrombosis

Key Findings & Data:MATERIAL AND METHOD: The combination protocol for TT consists of, Streptokinase 250000 units intravenous bolus administration in 30 minutes, later 100000 units/hour Streptokinase and 1-2 mlt/hour heparin.

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Conclusion & Impact:RESULTS: In our 5 cases with 6 trials, the overall succes was 83%.

🔬Design:Research Article

📍Scope:Comprehensive Sample

⚙️Variables:Hastalık oranı · Aort kapağı · Kalp kapağı protezleri

Abstract

AIM: Prosthetic mechanical heart valve thrombosis is a rare but potentially lethal clinical situation. Therapeutic choices for PVT are rereplacement, thrombectomy or thrombolytic therapy (TT). In order to evaluate the effectivity of TT, we retrospectively revealed our experience. MATERIAL AND METHOD: The combination protocol for TT consists of, Streptokinase 250000 units intravenous bolus administration in 30 minutes, later 100000 units/hour Streptokinase and 1-2 mlt/hour heparin. RESULTS: In our 5 cases with 6 trials, the overall succes was 83%. The follow-up period was the longest in case 2 with 3 years and in the follow-up period of the rest there was no complication. The controls were made with echocardiography or cinefluoroscopy. In the literature, numerous cases of TT have been reported with success rates of 70 to 100%. In some, TT have been the first line of therapy for cardiac valve thrombosis. CONCLUSION: In conclusion, TT for the left-sided PVT, is an alternative therapy to reoperation. TT especially in patients with NYHA FC III-IV congestive heart failure whose reoperative mortality rate seems to be high, is the ideal choice of therapy. However as seen in some series, TT maybe the first line of therapeutic choice if long term follow-up and much more experience is gained.

Özet

AMAÇ: Protez kapak trombozu (PKT), mekanik kalp kapak protezlerinin en mortal seyreden komplikasyonudur. PKT tedavisinde seçenekler cerrahi olarak rereplasman, trombektomi veya medikal olarak trombolitik tedavidir (TT). TT'nin güvenilirliği ve etkinliğini irdelemek amacıyla kliniğimizde uygulanan TT vakalarını retrospektif olarak inceledik. GEREÇ VE YÖNTEM: Trombolitik tedavi protokolü, Streptokinaz 250000 ünite iv olarak 30 dakikada infüzyon ve sonrasında 100000 ünite/saat idame ile heparin 1-2 mlt/saat kombinasyonudur. BULGUAR: Yapılan 5 vakada denenen 6 TTde 5 başarılı sonuç alınmıştır (%83). Vaka serisinde en uzun takip 3 yıllık olup diğer vakaların kontrollerinde EKO ve sinefloroskopik tetkiklerde sorun gözlenmemiştir. Literatürde TT için %70-100 arası başarı oranları verilmesi, kolay uygulanabilirliği ve kontrol edilebilirliği sayesinde kapak trombozunda TT'nin ilk başlangıç tedavisi olarak kullanımı ve başarısızlığı halinde reoperasyona gidilmesi yönünde çalışmalar gözlenmektedir. SONUÇ: Sol yanlı PKT için TT, cerrahi kapak replasmanına veya trombektomiye alternatif bir tedavi yöntemidir. TT düşük ve kabul edilebilir bir mortalite, morbidite hızına sahiptir. TT özellikle NYHA FK III ve IV konjestif kalp yetmezliği semptomları olan hastalarda, operatif mortalitenin yüksekliği nedeniyle, ideal tedavi olarak kabul görmektedir, ancak bazı serilerde olduğu gibi TT' nin mekanik kapak trombozunda ilk tedavi seçeneği olarak kullanılabilirliği yapılacak uzun dönem takibi olan geniş serilerle mümkün olabilecektir.

Keywords

Hastalık oranı Aort kapağı Kalp kapağı protezleri Mitral kapak Ölüm oranı Streptokinaz Tromboz Trombolitik tedavi Morbidity Aortic Valve Heart Valve Prosthesis Mitral Valve Mortality Streptokinase Thrombosis Thrombolytic Therapy

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Cite This Article

KÜÇÜKAKSU, S., İŞCAN, H. Z., TARCAN, K. O., NİSANOĞLU, V., YILDIZ, Ü., ŞENER, E., TAŞDEMİR, O. (2000). Thrombolytic therapy via streptokinase for prosthetic heart valve thrombosis. MN Kardiyoloji, Cilt: 7 - Sayı: 5, 393–397. https://ajindex.com/articles/297829

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